Knowledge and attitudes of Moroccan hemodialysis patients toward renal transplantation: did we inform our patients enough?

BACKGROUND: Chronic kidney disease is a worldwide public health problem. It is essential to offer patients all appropriate and available treatment options. However, it seems that nephrologists do not talk enough about renal transplantation to their patients. AIM: This pilot study assessed the knowledge, attitudes, and beliefs of hemodialysis patients related to renal transplantation. METHODS: The research included 120 hemodialysis patients from three centers. The instrument was a structured questionnaire completed in individual interviews. None of the respondents had been transplanted. The subjects addressed in the document were sociocultural status, willingness to be transplanted, ability to identify major benefits and risks of renal transplantation, and knowledge of religious attitudes toward living and cadaveric organ donation and transplantation. RESULTS: Among the 120 patients were 53.3% women with an overall mean age of 50.5±10.3 years. The mean duration of hemodialysis was 7.7±5.8 years. Only 15% were highly educated, and 55% had a moderate economic status. Of the 120 respondents, 76% stated that they were willing to be transplanted. However, 41.7% thought that transplantation was more expensive than hemodialysis. Only 65.8% believed that renal transplantation offered a better quality of life. They were afraid of multiple complications and return to dialysis. Of the 120 respondents, 65.9% believed that Islam is adverse to cadaveric donation, a rate that fell to 35.8% concerning living donors. Fifty-four percent of respondents stated that they wanted to obtain more information about renal transplantation. CONCLUSION: There is a need to increase awareness about organ donation and transplantation among hemodialysis patients and their families.

Cardiovascular morbidity and endothelial dysfunction in chronic haemodialysis patients: is homocyst(e)ine the missing link?

BACKGROUND: Haemodialysis patients exhibit an excessive burden of atherothrombotic disease, which is not explained adequately by traditional risk factors. Hyperhomocyst(e)inaemia, a consistent finding in uraemic patients, is now widely recognized as an independent risk factor for vascular disease. The aim of this study was to examine the hypothesis that hyperhomocyst(e)inaemia is associated with cardiovascular complications in dialysed patients. METHODS: In a cohort of 63 stable chronic haemodialysis patients, we examined the causal relationship between hyperhomocyst(e)inaemia and vascular endothelial and haemostatic function. All their markers were determined before and after an 8-week course of a 10 mg per day oral folate supplementation, a manoeuvre known to decrease hyperhomocyst(e)inaemia in uraemic patients. RESULTS: History of at least one cardiovascular atherothrombotic event was present in 47.6% of the haemodialysed patients, and radiographic evidence of vascular calcifications in 70%. Hyperhomocyst(e)inaemia was found in all patients, averaging 3.5-fold the upper limit of normal values (P<0.001), despite the lack of clinical and biological evidence of malnutrition. Fibrinogen, von Willebrand factor and plasminogen activator inhibitor type 1, but not endothelin 1, were significantly higher in haemodialysis patients than in controls. After adjustment for all variables, past history of cardiovascular events was independently associated with higher levels of homocyst(e)inaemia only (odds ratio (OR) 1.06; 95% confidence interval (CI) 1.01-1.12; P<0.026). The presence of aortic calcifications was independently and significantly associated with age (OR 1.37; 95% CI 1.07-1.75; P<0.025), homocyst(e)inaemia (OR 1.14; 95% CI 1.02-1.27; P<0.05) and fibrinogen concentration only (OR 9.74; 95% CI 1.25-75.2; P<0.05). None of the endothelial haemostatic factors was, however, related to homocyst(e)ine levels. Mid-term folate supplementation decreased plasma homocyst(e)ine levels significantly without achieving normal values. No significant change of endothelial-haemostatic markers was observed, however, despite the drop in plasma homocyst(e)ine. CONCLUSIONS: Hyperhomocyst(e)inaemia is associated with increased cardiovascular risk in haemodialysis patients. Folate supplementation was partially effective in lowering hyperhomocyst(e)inaemia, but its usefulness in terms of reduction in cardiovascular morbidity and mortality remains to be determined in prospective trials.